8Fundamentals of Nursing: The Art & Science of Person Centered Care, 10th Edition; Taylor, Lynn, Bartlett. Chapter 8 Communication

The charge nurse overhears an AP yelling loudly to a patient who is hard of hearing, while transferring them from the bed to a chair. Upon entering the room, which response by the charge nurse is most appropriate?

a.“Please speak more quietly so you don’t disturb the other patients.”

b. “Let me help you with your transfer technique.”

c. “When you are finished, be sure to apologize for shouting.”

d. “When your patient is safe and comfortable, meet me at the desk.”

d. “When your patient is safe and comfortable, meet me at the desk.”

The charge nurse should direct the AP to see to the patient’s safety, then address any concerns privately. The nurse then can discuss appropriate use of therapeutic communication

A public health nurse is leaving the home of a young mother who has an infant with special needs. The neighbor states, “How is she doing, since the baby’s father is no help?” What is the nurse’s best response?

a. “New mothers need support.”

b. “The lack of a father is difficult.”

c. “How are you today?”

d. “It is a very sad situation.”

a. “New mothers need support.”

The nurse must maintain confidentiality when providing care. The statement “New mothers need support” is a general statement that all new parents need help. The statement is not judgmental of the family’s roles. “How are you today?” is dismissive of the neighbor’s question.

A toddler with vomiting, diarrhea, and dehydration is being seen at an acute care center. During the admission interview, what question will the nurse ask the parents to elicit the most useful information?

a. “Watching your child vomiting and in discomfort must have been scary.”

b. “This started yesterday, correct?”

c. “Has this child has had anything to drink?”

d. Could you tell me the color and approximate amount of the vomiting?

d. Could you tell me the color and approximate amount of the vomiting?

Using a clarifying question or comment allows the nurse to gain an understanding of the parents’ observations, avoiding misunderstandings that could lead to an inappropriate nursing diagnosis. A reflective question technique involves repeating what the person has said or describes the person’s feelings. Assertive questions are direct, demonstrating the ability to stand up for self or others, using open and honest communication. Open-ended questions encourage free verbalization and expression of what the parents believe to be true.

A nurse enters a patient’s room and examines the patient’s intravenous (IV) fluids and cardiac monitor. When asked, “who are you?”, which response by the nurse is most appropriate?

a. “I’m just the IV therapist checking your IV.”

b. "I’ve been transferred to this division and will be caring for you.”

c. “I’m sorry, my name is John Smith and I am your nurse.”

d. “I am John Smith, your nurse, and I’ll be caring for you until 11 PM.”

d. “I am John Smith, your nurse, and I’ll be caring for you until 11 PM.”

The nurse should identify themselves, ensure the patient knows what will be happening, and the duration of their relationship.

A nurse enters the room of a patient with cancer. The patient is crying and states, “I feel so alone.” How will the nurse best communicate a therapeutic response?

a. The nurse stands at the patient’s bedside and states, “I understand how you feel. My mother said the same thing when she was ill.”

b. The nurse places a hand on the patient’s arm and states, “You feel so alone.”

c. The nurse stands in the patient’s room and asks, “Why do you feel so alone? Your wife has been here every day.”

d. The nurse holds the patient’s hand and asks, “Tell me what feeling so alone is like for you?”

d. The nurse holds the patient’s hand and asks, “Tell me what feeling so alone is like for you?”

The use of touch conveys acceptance, and the implementation of an open-ended question allows the patient time to verbalize freely.

A primary nurse is preparing a discharge plan for a patient who has been hospitalized following a double mastectomy. Which statement is most appropriate for the nurse to use in the termination phase of the therapeutic relationship?

a. “Let’s review the progress you’ve made in meeting your goals.”

b. “I’d like to review your medication schedule with you.”

“c. I need to document today’s teaching session in the electronic health record.”

d. “Should we include your family in today’s session?”

a. “Let’s review the progress you’ve made in meeting your goals.”

The termination phase occurs when the conclusion of the initial agreement is acknowledged. Discharge planning correlates with the termination phase of a therapeutic relationship and the progress toward the patient’s goals are reviewed.

A nursing student is nervous and concerned about working at a clinical facility. Which action would best decrease anxiety and help ensure successful delivery of patient care?

a. Determining the established goals of the institution

b. Ensuring that verbal and nonverbal communication is congruent

c. Engaging in self-talk to plan the day and decrease fear

d. Speaking with fellow colleagues about how they feel

c. Engaging in self-talk to plan the day and decrease fear

By engaging in positive self-talk, or intrapersonal communication, the nursing student can plan the day, decrease fear and anxiety, and enhance clinical performance.

A nurse says to their nurse manager, “I need the day off, and you didn’t give it to me!” The manager replies, “I wasn’t aware you needed the day off, and it isn’t possible since staffing is inadequate.” How could the nurse best modify the communication for a more positive interaction?

a. “I placed a request to have 8th of August off for a doctor’s appointment, but I’m scheduled to work.”

b. “Could I make an appointment to discuss my schedule with you? I requested the 8th of August off for a doctor’s appointment.”

c. “I will need to call in on the 8th of August because I have a doctor’s appointment.”

d. “Since you didn’t give me the 8th of August off, will I need to find someone to work for me?”

b. “Could I make an appointment to discuss my schedule with you? I requested the 8th of August off for a doctor’s appointment.”

Effective communication involves sending clear, nonthreatening, and respectful information to the receiver. The nurse identifies the subject of the meeting and determines a mutually agreed upon time.

During a nursing staff meeting to discuss delayed documentation, the nurses unanimously agree that they will ensure all vital signs are reported and charted within 15 minutes following assessments. This decision is consistent with which characteristics of effective communication? Select all that apply.

a. Group decision making

b. Group leadership

c. Group power

d. Group identity

e. Group patterns of interaction

f. Group cohesiveness

a. Group decision making

d. Group identity

e. Group patterns of interaction

f. Group cohesiveness

Solving problems involves group decision making; ascertaining the task is important and agreeing to complete the task on time is characteristic of group identity. Group patterns of interaction involve honest communication and member support; cohesiveness occurs when members generally trust each other, have a high commitment to the group, and a high degree of cooperation. Group leadership occurs when groups use effective styles of leadership to meet goals; with group power, sources of power are recognized and appropriately used to accomplish group outcomes.

A nurse notices a patient is walking to the bathroom with a stooped gait, facial grimacing, and grunting sounds. Based on these nonverbal cues, what action will the nurse take next?

a. Assess for pain and the need for analgesia.

b. Ask the patient if they feel anxious.

c. Offer to sit with the patient and listen to their feelings.

d. Suggest the patient increase their fluid intake to prevent constipation.

a. Assess for pain and the need for analgesia.

A patient who presents with nonverbal communication of a stooped gait, facial grimacing, and grunting sounds is most likely communicating pain. The nurse should clarify this nonverbal behavior.

A nursing student is preparing to administer morning care to a patient. What question by the student is most important to ask?

a. “Would you prefer a bath or a shower?”

b. “May I help you with a bed bath now or later this morning?”

c. “I will be giving you your bath. Do you use soap or shower gel?”

d. “I prefer a shower in the evening. When would you like your bath?”

b. “May I help you with a bed bath now or later this morning?”

The nurse should ask permission to assist the patient with a bath. This allows for patient preferences and consent for care that involves entering the patient’s personal space.

A nurse enters a patient’s room and finds them vomiting bright red blood. After taking vital signs, the nurse communicates the event to the health care provider using the SBAR format. Which information will the nurse include in the “A” portion of the SBAR communication?

Exhibit: Electronic health record (EHR)

Past medical history

Vital Signs

Peptic ulcer

T 98.8°F, P 111, RR 20, BP 98/50

Bleeding disorder

Pulse oximetry 96%

a. Admitted with peptic ulcer and bleeding disorder

b. Found vomiting in bathroom

c. Anti-ulcer medication recommendation

d. Vital signs, oxygen saturation, bright red emesis

d. Vital signs, oxygen saturation, bright red emesis

The SBAR method is used to improve hand-off communication. SBAR, which stands for Situation, Background, Assessment, and Recommendations, provides a clear, structured, and easy to use framework. Vital signs, oxygen saturation, and the presence of emesis and its color are assessments.

The nurse preceptor and a new graduate nurse on the surgical unit are performing preoperative assessments on a group of patients. What statement by the graduate nurse requires the preceptor to intervene?

a. “I am sure everything will be fine; you have nothing to worry about.”

b. “When you return from surgery, you’ll need to cough and deep breathe.”

c. “Many people on this unit have had that procedure with good success.”

“d. You seem fearful, can I answer any questions about the procedure?”

a. “I am sure everything will be fine; you have nothing to worry about.”

Telling a patient that everything will be fine is a cliché. This statement gives false assurance and may give the patient the impression that the nurse is dismissive of a patient’s concerns or condition.

A patient states, “I have been experiencing complications of diabetes.” What question will the nurse use to elicit additional information?

a. “Do you take two injections of insulin to prevent complications?”

b. “Are you using diet and exercise to help regulate your blood sugar?”

c. “Have you been experiencing the complications of neuropathy?”

d. “Can you tell me about the complications you’ve experienced?”

d. “Can you tell me about the complications you’ve experienced?”

Requesting information regarding the patient’s specific complications of diabetes will guide the nurse to further questioning and related assessments.

During an interaction with a patient diagnosed with epilepsy, a nurse notes that the patient is silent after hearing the plan of care. How does the nurse best respond? Select all that apply.

a. Fill the silence with lighter conversation directed at the patient.

b. Use the time to perform the care that is needed uninterrupted.

c. Discuss the silence with the patient to ascertain its meaning.

d. Allow the patient time to think and explore inner thoughts.

e. Determine if the patient’s culture requires pauses between conversation.

f. Arrange for a counselor to help the patient cope with emotional issues.

c. Discuss the silence with the patient to ascertain its meaning.

d. Allow the patient time to think and explore inner thoughts.

e. Determine if the patient’s culture requires pauses between conversation.

Appropriate use of silence allows the patient to initiate or to continue speaking; the nurse can reflect on what has been shared while observing the patient without having to concentrate simultaneously on conversation. In due time, the nurse might discuss the meaning of silence with the patient. The nurse considers whether the patient’s culture may require longer pauses between verbal communication. Fear of silence sometimes leads to excessive talking by the nurse, displacing focus from the patient. The nurse should not assume silence requires a consult with a counselor.